Mental Stress-Induced Myocardial Ischemia: Differences Between the Sexes

HealthDay News — Men and women have different cardiovascular reactivity mechanisms for mental stress-induced myocardial ischemia (MSIMI), according to a study published in Arteriosclerosis, Thrombosis, and Vascular Biology.

Samaah Sullivan, MPH, from Emory University in Atlanta, and colleagues collected baseline data from a prospective cohort study of 678 patients with coronary artery disease who underwent myocardial perfusion imaging before and during a public speaking stressor. The authors calculated the rate-pressure product response as the difference between the maximum value during the speech minus the minimum value during rest. The ratio of pulse wave amplitude during the speech over resting baseline was used to measure peripheral vasoconstriction by peripheral arterial tonometry. The percent of left ventricle that was ischemic was used to define MSIMI.

The researchers found that a higher rate-pressure product response was reported in men, but not in women, with MSIMI than those without MSIMI; in women, those with MSIMI vs without MSIMI had a significantly lower peripheral arterial tonometry ratio. In men, each 1000-U increase in rate-pressure product response was correlated with a 0.32% increase in inducible ischemia; for women, each 0.1-U decrease in peripheral arterial tonometry ratio was correlated with a 0.23% increase in inducible myocardial ischemia. The results were independent of conventional myocardial ischemia induced by stress.

“For women, stress-induced peripheral vasoconstriction with mental stress, and not increased hemodynamic workload, is associated with MSIMI, whereas for men, it is the opposite,” the authors wrote.

Reference

Sullivan S, Hammadah M, Al Mheid I, et al. Sex differences in hemodynamic and microvascular mechanisms of myocardial ischemia induced by mental stress [published online December 21, 2017]. Arterioscler Thromb Vasc Biol. doi:10.1161/ATVBAHA.117.309535.